Öz
Bu olgu sunumunda acil servise bilinç bulanıklığı ile başvuran, non-steroid anti-inflamatuar ilaç kullanımına bağlı multiorgan yetmezliği gelişen hastayı sunmayı amaçladık. Acil servise 32 yaşında erkek hasta uykuya meyil ve bilinç bulanıklığı şikayeti ile getirildi. Bilinen kronik herhangi bir hastalığının olmadığı, alkol kullanım ve madde bağımlılığı hikayesinin olmadığı söylendi. Hasta yakınlarından alınan anamnezde son 1 yıldır diş ağrıları için aralıklarla naproksen + kodein içeren tablet ilaç kullandığı öğrenildi. Yapılan fizik muayenesinde genel durumu orta, bilinci açık, uykuya meyilli ve letarjik, konuşma bozukluğu, terleme, pupillerinde bilateral miyozis saptandı. Oda havasında oksijen saturasyonu (SaO2) 89’lara kadar düşüp nazal oksijen desteği ile SaO2 >96 olması dışındaki vitalleri stabildi. Bakılan laboratuvar sonuçlarında 10 katı geçen transaminaz yüksekliği ve protrombin zamanında uzama saptanan hasta akut karaciğer yetmezliği ön tanısı ile hastanenin yoğun bakım ünitesinde tedavi ve takibine devam edildi. Acil servise bilinç bulanıklığı ile hastaneye başvuran, herhangi bir komorbid hastalığı olmayan ve özellikle genç hastalarda ilaç kullanımının sorgulanması unutulmamalıdır. Karaciğer yetmezliği tespit edilen bu hastalarda, nakil yapılabilecek durumların gözden kaçmaması gerekir. Transplantasyon endikasyonu olması durumunda, organ nakillerinin yapıldığı merkezlerde tedavi ve takipleri yapılmalıdır.
Anahtar Kelimeler
Naproksen ve kodein hepatotoksisite multiorgan yetmezliği karaciğer nakli
Destekleyen Kurum
Harran Üniversitesi Tıp Fakültesi
Teşekkür
Makalemizi dikkate aldığınız için teşekkür ederiz.
Kaynakça
- 1. Teoh NC, Chitturi S, Farrel GC. Liver disease caused by drugs. Feldman N, Friedman LS, Brandt LJ. Sleisenger and Fordtran’s Gastrointestinal and Liver Disease:Pathophysiology/Diagnosis/Management. 9th edition, SaundersElsevier, 2010,1413-1446.
- 2. Dilman R, Bektas M, Cinar K, et al. The characteristics and clinical outcome of drug-induced liver injury: A single center experience. J Clin Gastroenterol.2010;44:128-132.
- 3. Avrupa Karaciğer Çalışmaları Derneği. Elektronik adres: easloffice@easloffice.eu, Klinik uygulama kılavuzları paneli, Wendon, J, et al. Akut (fulminan) karaciğer yetmezliğinin tedavisine ilişkin EASL Klinik Pratik Kılavuzları. J Hepatol.2017;66:1047.
- 4. Lee WM. Akut karaciğer yetmezliğinin etiyolojileri. Semin Liver Dis.2008;28:142.
- 5. Bernal W, Auzinger G, Dhawan A, Wendon J.Akut karaciğer yetmezliği. Lancet.2010;376: 190.
- 6. Lanagran ML, Robles M, Lucena MI, et al. Hepatotoxicity in 2011-advancing resolutely. Rev Esp Enferm Dig 2011;103:472-79.
- 7. Maddukuri VC, Bonkovsky HL. Herbal and dietary supplement hepatotoxicity.Clinical Liver Disease 2014;4:1-3.
- 8. Kayaalp C, Ersan V, Yılmaz S. Acute liver failure in Turkey: A systematic review. Turk J Gastroenterol 2014;25:35-40
- 9. Zimmerman HJ, Ishak KG. Hepatic injury due to drugs and toxins. In: MacSween RNM, Burt A, Portman B eds. Pathology of the liver. 4th ed. Philadelphia: Churchill Livingstone; 2002;14:622–709.
- 10. Broulac-Sage P, Balabaud C. Toxic and drug induced disorders of the liver. In Odze R, Goldblum J, Crawford J eds. Surgical Pathology of the GI tract, Liver, Biliary tract and Pancreas. Philadelphia: Saunders; 2004;833–61.
- 11. Lee R. Diagnostic liver pathology. First ed. St Louis: Mosby;1994;342–78.
- 12. Fontana RJ. Acute liver failure due to drugs. Semin Liver Dis.2008;28:175-87.
- 13. Kaplowitz N. Idiosyncratic drug hepatotoxicity. Nat Rev Drug Discov 2005;4:489-499
- 14. Arıcı S. Toksik Hepatit. Pamukkale Tıp Dergisi. 2008;1:113-9.
- 15. Goodman Z, Ihsak K. Medical diseases of the liver. In Silverberg’s Principles and practice of Surgical Pathology and Cytopathology. 4th ed. Elsevier: Churchill Livingstone; 2006;1475–1500.
- 16. Andrade RJ, Lucena MI. Drug-induced hepatotoxicity. N Engl J Med 2003; 349:1974–6.
- 17. Hong H, Tong W. Emerging efforts for discovering new biomarkers of liver disease and hepatotoxicity. Biomark Med 2014;8:143-6.
- 18. Zimmerman HJ, Ishak KG. General aspects of druginduced. Gastroenterol Clin North Am 1995;24:739-57.
- 19. Norris W, Paredes AH, Lewis JH. Drug-induced liver injury in 2007. Curr Opin Gastroenterol.2008;24:287-97.
- 20. Chalasani NP, Hayashi PH, Bonkovsky HL, Navarro VJ, Lee WM, Fontana RJ. ACG Clinical Guideline: the diagnosis and management of idiosyncratic drug-induced liver injury. Am J Gastroenterol. 2014;109:950-66.
- 21. Fareed A, Stout S, Casarella J, Vayalapalli S, Cox J, Drexler K. Illicit opioid intoxication: diagnosis and treatment. Subst Abuse. 2011;5:17-25.
- 22. Randall CB. Disposition of Toxic Drugs and Chemicals in Man. 7th Edition. Biomedical Publication, Foster City, California, 2004.
- 23. Katzung BG. Basic & Clinical Pharmocology. 10th Edition. The McGraw-Hill Companies, New York, 2007.
- 24. Martindale: The Complet Drug Referance. The Pharmaceutical Press, London, 2007.
- 25. Eichelbaum M, Evert B. Influence of pharmacogenetics on drug disposition and responce. Clin Exp Pharmacol Physiol 1996;23:983-5.
- 26. Judith Tintinalli JS, O. John Ma, David Cline, Rita Cydulka, Garth Meckle (ed): Tintinalli’s Emergency Medicine A Comprehensive Study Guide 7 th edition. 2011.
- 27. Katzung BG. Basic & Clinical Pharmocology. 10th Edition. The McGraw-Hill Companies, New York, 2007.
Öz
In this case report, we aimed to present a patient who presented to the emergency department with confusion and developed multiorgan failure due to the use of non-steroidal anti-inflammatory drugs. A 32-year-old male patient was brought to the emergency department with complaints of drowsiness and confusion. It was said that she did not have any known chronic disease and had no history of alcohol use or substance abuse. In the anamnesis taken from the relatives of the patient, it was learned that she had been using tablets containing naproxen + codeine intermittently for the last 1 year for toothache. On physical examination, her general condition was moderate, she was conscious, sleepy and lethargic, speech disorder, sweating, and bilateral miosis in her pupils were found. Her vitals were stable, except that the oxygen saturation (SaO2) in room air decreased to 89 and SaO2 was> 96 with nasal oxygen support. In the laboratory results, the transaminase elevation exceeding 10 times and prothrombin time prolongation were detected. The patient was treated and followed up in the intensive care unit of the hospital with a preliminary diagnosis of acute liver failure. It should not be forgotten that the use of drugs should be questioned in patients who apply to the emergency department with clouding of consciousness, do not have any comorbid diseases, and especially in young patients. In these patients with hepatic insufficiency, the situations in which transplantation can be performed should not be overlooked. In case of transplantation indication, treatment and follow-up should be done in centers where organ transplantation is performed.
Anahtar Kelimeler
Naproxen and codeine hepatotoxicity multiorgan failure liver transplantation
Kaynakça
- 1. Teoh NC, Chitturi S, Farrel GC. Liver disease caused by drugs. Feldman N, Friedman LS, Brandt LJ. Sleisenger and Fordtran’s Gastrointestinal and Liver Disease:Pathophysiology/Diagnosis/Management. 9th edition, SaundersElsevier, 2010,1413-1446.
- 2. Dilman R, Bektas M, Cinar K, et al. The characteristics and clinical outcome of drug-induced liver injury: A single center experience. J Clin Gastroenterol.2010;44:128-132.
- 3. Avrupa Karaciğer Çalışmaları Derneği. Elektronik adres: easloffice@easloffice.eu, Klinik uygulama kılavuzları paneli, Wendon, J, et al. Akut (fulminan) karaciğer yetmezliğinin tedavisine ilişkin EASL Klinik Pratik Kılavuzları. J Hepatol.2017;66:1047.
- 4. Lee WM. Akut karaciğer yetmezliğinin etiyolojileri. Semin Liver Dis.2008;28:142.
- 5. Bernal W, Auzinger G, Dhawan A, Wendon J.Akut karaciğer yetmezliği. Lancet.2010;376: 190.
- 6. Lanagran ML, Robles M, Lucena MI, et al. Hepatotoxicity in 2011-advancing resolutely. Rev Esp Enferm Dig 2011;103:472-79.
- 7. Maddukuri VC, Bonkovsky HL. Herbal and dietary supplement hepatotoxicity.Clinical Liver Disease 2014;4:1-3.
- 8. Kayaalp C, Ersan V, Yılmaz S. Acute liver failure in Turkey: A systematic review. Turk J Gastroenterol 2014;25:35-40
- 9. Zimmerman HJ, Ishak KG. Hepatic injury due to drugs and toxins. In: MacSween RNM, Burt A, Portman B eds. Pathology of the liver. 4th ed. Philadelphia: Churchill Livingstone; 2002;14:622–709.
- 10. Broulac-Sage P, Balabaud C. Toxic and drug induced disorders of the liver. In Odze R, Goldblum J, Crawford J eds. Surgical Pathology of the GI tract, Liver, Biliary tract and Pancreas. Philadelphia: Saunders; 2004;833–61.
- 11. Lee R. Diagnostic liver pathology. First ed. St Louis: Mosby;1994;342–78.
- 12. Fontana RJ. Acute liver failure due to drugs. Semin Liver Dis.2008;28:175-87.
- 13. Kaplowitz N. Idiosyncratic drug hepatotoxicity. Nat Rev Drug Discov 2005;4:489-499
- 14. Arıcı S. Toksik Hepatit. Pamukkale Tıp Dergisi. 2008;1:113-9.
- 15. Goodman Z, Ihsak K. Medical diseases of the liver. In Silverberg’s Principles and practice of Surgical Pathology and Cytopathology. 4th ed. Elsevier: Churchill Livingstone; 2006;1475–1500.
- 16. Andrade RJ, Lucena MI. Drug-induced hepatotoxicity. N Engl J Med 2003; 349:1974–6.
- 17. Hong H, Tong W. Emerging efforts for discovering new biomarkers of liver disease and hepatotoxicity. Biomark Med 2014;8:143-6.
- 18. Zimmerman HJ, Ishak KG. General aspects of druginduced. Gastroenterol Clin North Am 1995;24:739-57.
- 19. Norris W, Paredes AH, Lewis JH. Drug-induced liver injury in 2007. Curr Opin Gastroenterol.2008;24:287-97.
- 20. Chalasani NP, Hayashi PH, Bonkovsky HL, Navarro VJ, Lee WM, Fontana RJ. ACG Clinical Guideline: the diagnosis and management of idiosyncratic drug-induced liver injury. Am J Gastroenterol. 2014;109:950-66.
- 21. Fareed A, Stout S, Casarella J, Vayalapalli S, Cox J, Drexler K. Illicit opioid intoxication: diagnosis and treatment. Subst Abuse. 2011;5:17-25.
- 22. Randall CB. Disposition of Toxic Drugs and Chemicals in Man. 7th Edition. Biomedical Publication, Foster City, California, 2004.
- 23. Katzung BG. Basic & Clinical Pharmocology. 10th Edition. The McGraw-Hill Companies, New York, 2007.
- 24. Martindale: The Complet Drug Referance. The Pharmaceutical Press, London, 2007.
- 25. Eichelbaum M, Evert B. Influence of pharmacogenetics on drug disposition and responce. Clin Exp Pharmacol Physiol 1996;23:983-5.
- 26. Judith Tintinalli JS, O. John Ma, David Cline, Rita Cydulka, Garth Meckle (ed): Tintinalli’s Emergency Medicine A Comprehensive Study Guide 7 th edition. 2011.
- 27. Katzung BG. Basic & Clinical Pharmocology. 10th Edition. The McGraw-Hill Companies, New York, 2007.
Ayrıntılar
| Birincil Dil | Türkçe |
|---|---|
| Konular | Klinik Tıp Bilimleri |
| Bölüm | Olgu Sunumu |
| Yazarlar | |
| Yayımlanma Tarihi | 31 Ağustos 2023 |
| Gönderilme Tarihi | 6 Nisan 2023 |
| Yayımlandığı Sayı | Yıl 2023 Cilt: 15 Sayı: 2 |
